Critical decision making in severe head injury management

  title={Critical decision making in severe head injury management},
  author={C. Tolias and Jonathan Wasserberg},
  pages={211 - 221}
The management of severe head injury (SHI) remains a major challenge not only for neurosurgeons but also for all other health professionals involved in the care of trauma patients. Any trauma patient with SHI is at risk of further neurological deterioration if appropriate measures are not instituted from the start of his or her treatment. Secondary insults due to ischaemic, hypotensive, and metabolic or other causes are still common, even in the most advanced neurocritical care settings… 



Further experience in the management of severe head injury.

A prospective and consecutive series of 225 patients with severe head injuries who were managed in a uniform way was analyzed to relate outcome to several clinical variables, and predictive correlations were equally strong in the entire series and in the subset of 158 patients with coma.

On guidelines for the management of the severe head injury.

  • P. Kirkpatrick
  • Medicine
    Journal of neurology, neurosurgery, and psychiatry
  • 1997
The charitable American Trauma Brain Foundation has assembled and financed an expert task force to suggest guidelines for the management of patients with severe head injury, and used a systematic process of review and critical analysis to gather the available evidence.

Prognosis of severe head injuries.

The authors have analyzed retrospectively a series of 288 consecutive patients with severe head injury observed between January, 1977, and May, 1980 and concluded that no sign has an absolute prognostic value when considered independently of its time course.

Decompressive surgery in the treatment of traumatic brain injury

  • J. Piek
  • Medicine
    Current opinion in critical care
  • 2002
There is strong evidence from prospective, uncontrolled trials that such an operation improves outcome in general and also has beneficial effects on various physiologic parameters that are known to be independent predictors for poor outcome.

Endotracheal intubation in the field improves survival in patients with severe head injury. Trauma Research and Education Foundation of San Diego.

Prehospital endotracheal intubation was associated with improved survival in patients with blunt injury and scene Glasgow Coma Score of 8 or less, especially those with severe head injury by anatomic criteria.

Treating head injuries

Improvements have been made in the management of this complex and heterogeneous condition over the past decade, and initial assessment and triage of patients is now based on the best available evidence.

Routine intracranial pressure monitoring in acute coma.

To determine whether routine ICP monitoring in all acute cases of severe coma reduces the risk of all-cause mortality or severe disability at final follow up, a large number of randomised controlled studies were searched.

Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours.

The delay from injury to operation was the factor of greatest therapeutic importance, and patients who underwent surgery within the first four hours had a 30 per cent mortality rate, as compared with 90 percent in those who had surgery after four hours.

Clinical trials in head injury.

This workshop proved to be very informative and yielded many insights into previous and future TBI trials, and it is hoped that these lessons will enhance the planning and design of future efforts in this important field of research.